This research is designed to examine the influence on a patient's dental health literacy of culture and education or knowledge within the framework of a complex health care system. Health literacy is one of four information domains in a social review that health care providers should conduct in their general assessment of a patient. Low literacy is associated with poorer health status, low rates of compliance with complicated medication regimens, high hospitalization rates, overuse of emergency services, and under-use of preventive health services. Culture is linked to health literacy by the values and language barriers that shape the perception and processing of health information. A broad conceptualization of the education system includes ongoing adult education and experiences. Health system factors include barriers to access dental care and number and type of health care visits and services. Three specific aims are proposed: 1) Revise the Rapid Estimate of Adult Literacy in Medicine (REALM) to incorporate dental terminology (REALM-D) and determine its association with knowledge, health values, and patient characteristics among culturally diverse patients; 2) Examine differences in numbers of urgent / emergency visits versus preventive/comprehensive visits by dental health literacy levels; and 3) Examine differences in the range of health promotion education services requested and received among patients with varied dental health literacy levels after controlling for cultural background (age, sex, race/ethnicity, preferred language). The goal of this feasibility study is two-pronged: to modify and expand a measure of dental health literacy, and to develop a process for prospectively utilizing an electronic patient record (EPR) to track patient interaction with the dental health care system and acquisition of oral health services. [unreadable] [unreadable]